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Sewer & Water Tie Card
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Address: 4878 161 st St
Cor��ractor: DLR
Permit Number: �. �C' 3 7 ��
Fina1 Date: �l�
Str�et Drain-Tile: No
Size of Water�Service: 1"
Comments: AIRTEST SANITARY OVER 20'J2 FITTINGS
THIS CARD MUST BE C�MPLETED AND ON-SITE AT TIME
OF SEWER & WATER INSPECTION
20195 Holyoke Avenue,Lakeville,MN 55044
952-985-4400•952-985-4499 fax
www.lakevillemn.gov